All about Complex Migraine

By Dr. Pallavi Sharma

Table of Contents


Migraine is a condition that affects the blood vessels in your head and can cause intense pain, nausea, or vomiting. Migraines affect millions of people worldwide and are the most common cause of disability in young women. Approximately two-thirds of migraine sufferers experience at least monthly attacks, while one-third have at least monthly attacks that are severe enough to require treatment with prescription medications.

Complex migraine differs from common migraine in that it accompanies other symptoms other than a single headache. Complex migraine is the umbrella term for disorders that change from the main disease such as atypical migraine, classic migraine, and migraine with aura.

What is complex migraine?

A Complex migraine is a form of migraine that affects an individual’s brain and body in a more severe way than simple migraine.

The term “complex migraine” is used to define a migraine syndrome in which the headaches are accompanied by additional symptoms such as nausea and vomiting.

Complex migraine is a rare, often-debilitating form of migraine that affects women more than men. It is characterized by a combination of neurological symptoms and severe pain.

The condition is divided into two subtypes: complex hemiplegic migraine and complex basilar (or pendulous) migraine. Complex hemiplegic migraine occurs when both hemiplegia and visual disturbance occur together. The patient will have a severe headache, with or without nausea, vomiting, photophobia, and phonophobia.

They may also experience weakness in their faces and limbs. This is usually accompanied by numbness or tingling in the face, arms, and legs. The patient may also experience seizures or temporary blindness if they lose consciousness for more than a few minutes at a time.

In addition to the classic triad of visual disturbances with blind spots, unilateral blindness, and hemiplegia (paralysis), patients with complex migraine may also report vertigo and nausea. In addition, some patients experience photophobia or phonophobia (sensitivity to light or sound).

Ophthalmoplegic Migraine

Ophthalmoplegic migraine (OPM) is a rare condition that causes severe headaches that originate at the back of the eye and move forward over time. The pain is often described as being similar to that of a hangover, but it can also be more intense and sharp. In some cases, the pain can be so severe that it causes vomiting and dizziness.

Silent Migraine

A silent migraine is a type of migraine that doesn’t cause pain or other symptoms at the time it occurs. It can happen to people who have migraines with an aura or who have had a previous silent migraine.

What Causes Complex Migraines?

Migraine is characterized by severe throbbing pain on one side of the head, usually accompanied by nausea and sensitivity to light. It can last for hours or days at a time, during which patients may also experience vomiting, dizziness, or sensitivity to sound or smell.

The underlying cause of migraine is still under debate and is believed to be due to genetic and environmental factors.

Complex Migraine Triggers

Common migraine triggers can trigger complex migraines too.

Environmental triggers

weather changes

  • bright lights
  • strong smell


  • Chocolate, cheese, caffeine, alcohol, food additives:

Hormonal changes

Physical changes

  • stress
  • depression
  • Sleep disorders

Complex migraine risk factors

Migraines affect the same area three times higher in women than in men. It runs in families.

Most people with hemiplegic migraine will have one or fewer migraine episodes for the rest of their lives, with a 50% chance of genetic transmission.

The Phases of Hemiplegic Migraine

Hemiplegic migraine is a type of migraine that occurs in the brain stem, which is located at the base of the brain. Hemiplegic migraines are typically characterized by a combination of nausea and vomiting, visual disturbances (including blindness), and severe headaches.

In many cases, hemiplegic migraines can be very incapacitating, causing people to lose consciousness or even experience loss of motor function. They can also cause life-threatening complications if not treated properly.

The two phases of a hemiplegic migraine are an aura and a prodrome.

Prodrome- Phase 1

During an aura phase, you may experience visual disturbances (such as blind spots) or changes in your vision that last for several minutes up to several hours before you feel a full-blown headache. You may also feel dizzy or even lose consciousness and have speaking difficulties during this time.

Unlike other types of migraine, the symptoms that a patient experiences during an aura might last for weeks.

This phase lasts from five to 30 minutes and is characterized by feelings of weakness or tingling in the extremities or face (especially on one side). The patient may also experience numbness or tingling in their arms and legs for several hours after their headache has ended.

Headache Phase 2 :

The second phase is characterized by headaches that are usually located on one side of the head. These attacks normally last from 15 to 45 minutes, but some patients have reported that these headaches last up to two hours. During this time period, patients will also experience nausea and vomiting, along with sensitivity to light and sound.

Treatment of Hemiplegic Migraine

The over-the-counter pain relievers or anti-inflammatory medications like ibuprofen are beneficial for heart health. If you have a history of migraines, then taking an NSAID like aspirin or ibuprofen might help reduce the severity and frequency of attacks.

Anti nausea medications like metocloprome. Anti-migraine medications like triptans, antiseizure medications, and calcium channel blockers:

Migraine medications are used to treat migraines. They work by reducing the levels of chemicals in your brain that are responsible for the pain of a migraine (called neurotransmitters). Medications that block these neurotransmitters include triptans (dihydroergotamine), ergotamines (ergotamine), serotonin agonists (triptans), anticonvulsants (phenyltoloxamine), antidepressants (venlafaxine), and others.

Prevention of Complex Migraines

Migraine prevention is a process that involves taking steps to reduce or eliminate the risk factors for migraine. There are simple steps to migraine.

Migraines often occur when the nervous system is overstimulated by stress or illness. The best way to prevent migraines is to relax and chill out for a while, get some sleep, take some time off from work, or take a walk outside with your pet.

  • Relax time and a good night’s sleep
  • Eating a healthy diet
  • Exercising regularly
  • Reducing stress levels by breathing exercises heating heat [t]
  • Taking medications as prescribed by your doctor (Triptans, calcium channel blockers, and anti-seizure medications)
  • Eating magnesium
  • Avoiding triggers like cheese, and chocolate, and cutting down on alcohol

When to See the Doctor

Though hemiplegic migraine can recover, it is difficult to identify it from the stroke at the beginning.

Hence, one-sided weakness of the body is an indication to reach the doctor. Your doctor may order a brain imaging CT or MRI to rule out stroke.


TeleHealthDoc articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Dr. Pallavi Sharma

Dr. Pallavi Sharma is one of Melbourne’s best, well respected cosmetic doctors and aims to provide longstanding anti-aging benefits for her clients. With over 11 years experience in Performing cosmetic procedures, Dr. Sharma has lectured medical professionals regarding cosmetic treatments and is heavily involved in providing up to date cosmetic treatments to her clients and friends.
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